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MICHAEL ERIC BANWART O.D.

>> Optometrist >> Eye and Vision Services Providers

Registrant NPI Number: 1295838316

Individual Registrant:
 MICHAEL ERIC BANWART O.D.
Gender: M
Sole Proprietor

Location and contact information for practice:
2001 N CENTRAL AVE  MARSHFIELD, WI 54449-8337 US
Tel: 715-486-9365  Fax: 715-486-1426

Contact information for business:
2401 MONIQUE LN APT 2  MARSHFIELD, WI 54449-2439 US
Tel: 406-868-7836  Fax: --

Registration Information:
NPI: 1295838316
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y152W00000XEye and Vision Services Providers
Optometrist
WI3005-035

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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